RECOVERY OF DAILY ACTIVITY PATTERNS IN PATIENTS AFTER ACL RECONSTRUCTION

Injuries of the anterior cruciate ligament are one of the most often occurring injuries during sports activities. For young active patients, surgical treatment with repair, augmentation or replacement of the involved structure(s) is advised. The present study compared the outcome after Ligamys repair and Semitendinosus reconstruction during the first six postoperative weeks with objective measurements of the activity/inactivity behavior in daily life

LOQTEQ® VA Periprosthetic Plate—A New Concept for Bicortical Screw Fixation in Periprosthetic Fractures: A Technical Note

Internal fixation using angle stable plates is the treatment standard in periprosthetic fractures around stable implants. To provide instant postoperative full weight-bearing, bicortical screw fixation is advisable but often surgically demanding. This work presents the first clinical results of the LOQTEQ® VA Periprosthetic Plate (aap Implantate AG, Berlin, Germany), a new plate system to simplify screw placement around implants. This plate system uses insertable hinges that allow for variable angle screw anchorage. Data of 26 patients with a mean age of 80 years and a mean follow-up of 13.9 months were retrospectively collected. Patients were clinically and radiologically examined. Bony union was achieved in 14 out of 15 patients with no signs of non-union or implant loosening. One patient, however, presented with implant failure. Clinical scores demonstrated acceptable results. Since the hinge plates are easy to apply, the first results are promising

Long-term outcome after uterine artery embolization in patients with symptomatic leiomyoma

Ziel der Arbeit: Die Uterusarterienembolisation (UAE) ist eine Therapieoption für Patientinnen mit symptomatischen Leiomyomen des Uterus. Die vorliegende Arbeit beschäftigt sich mit den klinischen Langzeitergebnissen in Bezug auf Symptomkontrolle und Lebensqualität bei Patientinnen nach UAE sowie mit möglichen Faktoren, die Therapieerfolg oder -versagen beeinflussen können. Material und Methoden: 380 Patientinnen wurden von 10/2000 bis 10/2007 behandelt und in die Auswertung einbezogen. Mit Hilfe eines standardisierten Fragebogens wurden Folgeeingriffe, Leiomyombeschwerden (Blutungs- und Druckbeschwerden) und Lebensqualität abgefragt. Folgeeingriffe, eine Verschlechterung der Symptomatik oder der Lebensqualität wurden als Therapieversagen gewertet. Mittels Kaplan-Meier-Analyse wurde die durchschnittliche ereignisfreie Zeit (Endpunkt: Therapieversagen) analysiert. Um festzustellen, ob klinische und anatomischen Kriterien einen Erfolg oder Misserfolg beeinflussen, wurde eine Cox-Regressions-Analyse genutzt. Bei einer Subgruppe (n=115) wurde 48 – 72 Stunden nach UAE eine kontrastmittelunterstützte Magnetresonanztomographie (MRT) durchgeführt und ein Zusammenhang zwischen Infarzierung des Leiomyomgewebes und klinischem Erfolg geprüft. Um einen Zusammenhang zwischen Beschwerden und anatomischen Ausgangsdaten treffen zu können, wurde eine Subgruppe (n=91) mit singulären Leiomyomen untersucht. Ergebnisse: Von 304 der 380 Patientinnen (80 %) erhielten wir verwertbare Antworten. Die Verlaufskontrolle erstreckte sich im Median über 5,7 Jahre (Spannweite: 3,1 – 10,1 Jahren) nach UAE. Die Kaplan- Meier-Analyse zeigte nach 10 Jahren ein Therapieversagen bei 23,3 % der behandelten Patientinnen. Patientinnen unter 40 Jahren weisen ein signifikant höheres Risiko für ein Therapieversagens im Verlaufszeitraum auf (Hazard Ratio: 2,28, p=0,049). Patientinnen nach UAE ohne Therapieversagen wiesen im Langzeitverlauf vergleichbare Werte der Lebensqualität zu dem eines nicht erkrankten Kollektivs auf (p<0,001). Patientinnen mit einer Infarzierung der Leiomyome unter 89 % hatten ein 22,2-fach erhöhtes Risiko (p<0,001) für ein Therapieversagen gegenüber der Gruppe mit 90 – 99% und 100 % Infarzierung. Bei Patientinnen mit reinen Blutungsbeschwerden und einer Infarzierung unter 89 % ist ein 40,5-fach höheres Risiko eines Therapieversagens im Vergleich zu einer Gruppe mit Blutungs- und Druckbeschwerden oder einer Infarzierung über 90 % zu verzeichnen. Es konnte kein signifikanter Zusammenhang zwischen den anatomischen Ausgangsdaten und Leiomyombeschwerden gezeigt werden. Schlussfolgerungen: Die UAE zur Behandlung symptomatischer Uterusmyome zeigt im Langzeitverlauf bei etwa 75 % der Patientinnen eine anhaltende Besserung der Leiomyombeschwerden und verschafft behandelten Patientinnen eine Lebensqualität, die der nicht betroffener Frauen vergleichbar ist. Es besteht keine Korrelation zwischen anatomischen Faktoren und Leiomyombeschwerden. Patientinnen < 40 Jahren mit reinen Blutungsstörungen haben ein höheres Risiko für ein Therapieversagen. Ein prognostischer Faktor für einen Langzeiterfolg ohne Re-Intervention ist die Infarzierung des Myomgewebes zu über 90 %.Purpose: Uterine artery embolisation (UAE) is a therapeutic option for patients with symptomatic leiomyomata fibroids of the uterus. The study presented here, evaluates the clinical long-term results of this procedure with regard to symptom control and quality-of-life of as well as factors that may influence therapeutic success or failure. Material and Methods: Between 10/2000 and 10/2007 380 patients were treated and included in this analysis. Using an standardized questionnaire data on re-interventions, fibroid-related symptoms (bleeding and pressure symptoms) and quality-of-life were collected. Re-interventions, worsening of fibroid-related symptoms or quality-of-life were defined as a failure of therapy. Using a Kaplan-Meier-Analysis the event- free survival (endpoint: therapy failure) was calculated. A cox regression analysis was carried out to determine if clinical or anatomical factors influence clinical outcome. A subgroup of patients (n=115) underwent contrast- enhanced MRI to investigate the relationship between infarction of fibroids and clinical outcome. Another subgroup of patients (n=91) with single fibroids were analyzed to determine if anatomical factors relate to the type of symptoms. Results: 304 of 380 patients (80 %) returned information that could be analyzed. Median follow-up was 5,7 years (range: 3,1 – 10,1 years). Kaplan- Meier-Analysis showed that ten years after UAE up to 23,3 % of women reported failure of therapy. Cox-regression analysis demonstrated that patients under the age of forty have a significant higher risk of clinical failure (Hazard Ratio: 2,28, p=0,049). Patients with a positive long-term result after UAE reported similiar Quality-of-life compared to a a group of patients without fibroids (p<0,001). Patients with an infarction rate of leiomyoma below 89 % had a 22,2-fold higher risk for therapy failure than women with a 90-99 % or 100 % infarction rate (p<0,001). The combination bleeding symptoms and an infarction rate of less than 89% was associated with a 40,5-fold increased risk for therapy failure as compared to a group of women with pressure and bleeding symptoms or an infarction rate >90%. No correlation between anatomical variables and fibroid-related symptoms could be found. Conclusion: UAE for symptomatic fibroids leads to long-term symptom control in 75 % of women and is associated with an improvement in quality-of-life comparable to women without disease. No correlation between anatomical factors and clinical symptoms was found. Women under age of 40 and bleeding symptoms are a higher risk for clinical failure after UAE. An infarction rate of > 90% of leiomyoma tissue after UAE is a strong positive predictor for clinical success

Cost-utility analysis of dynamic intraligamentary stabilization versus early reconstruction after rupture of the anterior cruciate ligament

Objectives The aim of this study was to evaluate the cost-effectiveness of the dynamic intraligamentary stabilization (DIS) technique in comparison with reconstructive surgery (ACLR) in the treatment of isolated anterior cruciate ligament (ACL) ruptures from the perspective of the community of insured citizens in Germany. Methods Because of the specific decision problem at hand, namely that with DIS the procedure has to take place within 21 days after the initial trauma, a decision tree was developed. The time horizon of the model was set to 3 years. Input data was taken from official tariffs, payer data, the literature and assumptions based on expert opinion when necessary. Results The decision tree analysis identified the DIS strategy as the superior one with 2.34 QALY versus 2.26 QALY for the ACLR branch. The higher QALY also came with higher costs of 5,398.05 € for the DIS branch versus 4,632.68 € for the ACLR branch respectively, leading to an ICER of 9,092.66 € per QALY. Results were robust after sensitivity analysis. Uncertainty was examined via probabilistic sensitivity analysis resulting in a slightly higher ICER of 9,567.13 € per QALY gained. Conclusion The DIS technology delivers an effective treatment for the ACL rupture at a favorable incremental cost-effectiveness ratio

The Müller acetabular reinforcement ring - still an option in acetabular revision of Paprosky 2 defects? Longterm results after 10 years

Aim of this study was to measure the clinical and radiological longterm outcome after acetabular revision arthroplasty using the Müller acetabular reinforcement ring. 96 patients with 103 revision arthroplasties and a mean age of 69 years (41 to 84) were included. The mean follow-up was 10 years (range 7 – 12). The radiologic analysis reports no signs of loosening in 76 %, 17 % showed possibly loosening and 7 % probable loosening. Definite radiologic loosening has not been detected. The mean center of rotation of the hip moved 0.15 cm (SD 0.74 cm) laterally and 0.1 cm (SD 0.97 cm) cranially based on the geometrically reconstructed center of rotation. A mean score of 58 points for the Harris Hip Score (range 14 – 93) indicated a poor functional outcome, while a mean value of 96 points (range 0 – 223) for the WOMAC Index indicated good results for functional outcome in daily living. The revision arthroplasty in cases with acetabular defects using the Müller acetabular reinforcement ring shows acceptable longterm results

Peri- and Interprosthetic Femoral Fractures&mdash;Current Concepts and New Developments for Internal Fixation

Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal fixation of periprosthetic fractures. Since the elderly are unable to follow partial weight bearing, stable solutions are required. Therefore, a high primary stability is necessary. Numerous options, such as new angular stable plate systems with additional options for variable angle screw positioning, already exist and are in the process of being further improved. Lately, individually produced custom-made implants are offering interesting alternatives to treat periprosthetic fractures

Additional file 1 of 2-year results of middle-aged patients with two-compartment cartilage lesions in one knee treated with two patient specific metal implants

Additional file 1

2‐year results of middle‐aged patients with two‐compartment cartilage lesions in one knee treated with two patient specific metal implants

Abstract Purpose Focal chondral lesions of the femur are currently treated with biological repair or arthroplasty. However, some patients are not suitable for either one due to lesion size, age, or prior biological treatment attempts. While singular patient‐specific focal mini metal implants already showed good results, the outcomes of bicompartmental implantation of these implants have not been discussed in the literature yet. This study aims to evaluate clinical outcomes of patients who underwent bicompartmental implantation of two patient‐specific implants. Methods This prospective, non‐randomized, non‐comparative pilot study evaluates results up to two years after bicompartmental implantation of two implants (Episealer Implant, Episurf, Stockholm, Sweden). A damage report is compiled using a special MRI program and patient specific implants are manufactured, including 3D‐printed surgical instruments to provide exact placement of the implant. The patients were assessed repeatedly using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) for pain during the follow‐up. Results The scores were evaluated three, 12, and 24 months after surgery and showed good results. The median in both scores improved from 37.7 for the KOOS5 preoperatively to 69.1 after 24 months and from 69 for the VAS for pain preoperatively to 9 after 24 months. Conclusion Overall, for the small study group presented, the early results are promising. With noticeable improvement in KOOS and VAS for pain after two years, patient specific implants appear to become relevant in future standardized treatment of femoral chondral lesions. Especially with bicompartmental implantation, full arthroplasty can be delayed even further. Level of Evidence I

A New System for Periprosthetic Fracture Stabilization—A Biomechanical Comparison

In recent years, an increase in periprosthetic femur fractures has become apparent due to the increased number of hip replacements. In the case of Vancouver type B1 fractures, locking plate systems offer safe procedures. This study compared the distal lateral femur plate (LOQTEQ®, aap Implantate AG) with a standard L.I.S.S. LCP® (DePuy Synthes) regarding their biomechanical properties in fixation of periprosthetic femur fractures after hip arthroplasty. We hypothesized that the new LOQTEQ system has superior stability and durability in comparison. Eighteen artificial left femurs were randomized in two groups (Group A: LOQTEQ®; Group B: L.I.S.S. LCP®) and tested until failure. Failure was defined as 10° varus deformity and catastrophic implant failure (loosening, breakage, progressive bending). Axial stiffness, loads of failure, cycles of failure, modes of failure were recorded. The axial stiffness in Group A with 73.4 N/mm (SD +/− 3.0) was significantly higher (p = 0.001) than in Group B (40.7 N/mm (SD +/− 2.8)). Group A resists more cycles than Group B until 10° varus deformity. Catastrophic failure mode was plate breakage in Group A and bending in Group B. In conclusion, LOQTEQ® provides higher primary stability and tends to have higher durability